bias

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

By Brian D. Earp 

* Note: this article has been re-posted at various other sites, sometimes with minor edits. This is the original and should be referred to in case of any discrepancies.

 

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

1. Experimental doubts 

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.

These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”

Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:

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Holier and happier than thou?

Are ethical people happier? Many philosophers have claimed this, from Plato and Aristotle onwards. A new study claims it is empirically true, or more exactly that ethical people are more satisfied with life.

The 2009 study looked at cross-country data from the World Values Survey from the US, Canada, Mexico and Brazil. It looked at  people who agreed with the view that it is never justifiable to engage in ethically questionable behaviours like avoiding fares on public transports, cheating on taxes or taking bribes (35%) compared the rest. Controlling for things like gender, income, age, health, being married etc. the study found being ‘ethical’ by this standard increased the likeliehood of being very satisfied with life fairly significantly. The effect size is like a modest increase in income. A good reason to try to become a better person, or (as the paper suggests) for governments that are trying to increase subjective well being to do it by improving moral conduct… or is it?

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Blaming victims, individuals or social structures?

When the Swedish politician Erik Hellsborn of the rather xenophobic Sweden Democrats party blogged that the massacre in Norway was really due to mass immigration and islamization that had driven the killer to extremes (link in Swedish), he of course set himself up for a harsh reprimand from the party chairman Jimmie Åkesson: “I do not share this analysis at all. One cannot blame individual human actions on social structures like this.”

While it is certainly politically rational for the party to try to distance themselves as far as they can from the mass-murderer Breivik (who mentioned them positively by name in his manifesto) this is of course a rather clear deviation from many previous comments from the party that do indeed seem to blame bad actions by people, such as terrorism, as due to Islam or other (foreign) social structures.

It is of course always enjoyable to see political movements you disagree with struggle with their internal contradictions. But this is an area where most of us do have problems: how much of the responsibility of an action do we assign to the individual doing it, and how much do we assign to the group the person belongs to?

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